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What rhythm is most common following cardiac arrest in adults?
VF
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For adult patients with ROSC, targeted temperature management is recommended. What is the goal body temperature and length of time of cooling?
Targeted temperature is 32 to 35 degrees Celsius for at least 24 hours
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During CPR, waveform capnography is less than 10 mm Hg. What may improve this number?
An advanced airway
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If PETCO2 abruptly increases to a normal value of 35 – 40 mm Hg, what would you consider?
ROSC - return of spontaneous circulation
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Synchronized cardioversion is the treatment of choice for what condition?
AFIB RVR
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How long should you check for a pulse?
No more than 10 seconds
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What four initial drugs should be considered for suspected MI?
- Morphine
- Oxygen
- Nitroglycerin
- Aspirin
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How long should you check for a pulse?
5 to 10 seconds
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If chest compressions must be interrupted, how long is the recommended limit?
10 seconds
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The first step in any emergency before patient assessment is to:
Check the site to ensure it is safe
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For a patient in respiratory arrest with a pulse how often do you give a breath?
Every 5 to 6 seconds
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For a patient in respiratory arrest with a pulse how often do you recheck the pulse?
Every 2 minutes
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What harm can be caused by hyperventilation?
Gastric inflation
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With suspected neck injury, how would you open the airway?
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If the jaw thrust was not effective, how would you open the airway with a suspected neck injury?
Head tilt-chin lift
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Why is an OPA NOT used on a conscious victim?
Because it may stimulate gagging and vomiting
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How do you measure for proper sizing of the OPA?
Place the OPA against the side of the face, when the flange of the OPA is at the corner of the mouth, the tip should be a the angle of the mandible
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What could happen if the OPA is too large?
It may obstruct the larynx or cause trauma to the laryngeal
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What could happen if the OPA is too small or incorrectly inserted?
May push the base of the tongue posteriorly and obstruct the airway
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When would you use an NPA?
When insertion of an OPA is technically difficult or dangerous
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How do you correctly size the NPA?
- Compare the outer circumference of the NPA with the inner aperture of the nares. The NPA should not be so large that it causes sustained blanching of the nostrils. Some providers use the diameter of the patient’s smallest finger as a guide to selecting the proper size
- The length of the NPA should be the same as the distance from the tip of the patient’s nose to the earlobe.
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What do you check immediately after insertion of an OPA or NPA?
Check for spontaneous respirations immediately after insertion of either an OPA or an NPA
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Is routine use of cricoid pressure recommended?
No
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How often are breaths given when an advanced airway is in place?
- Once every 6 seconds during cardiac arrest
- Once every 5 to 6 seconds during respiratory arrest
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When suctioning an endotracheal tube, how long would you apply suction?
No more than 10 seconds – to avoid hypoxemia, precede and follow suctioning attempts with a short period of administration of 100% oxygen
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If you were not sure if a patient has a pulse, would you begin compressions?
Yes!
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How does defibrillation affect the viable heart in VT/VF?
Cardioversion – shocks the heart into a sinus rhythm
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Prior to shocking, is it important to be sure oxygen is NOT flowing across the victim’s chest?
Yes because oxygen is flammable
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Waveform capnography monitors ETT placement but can it also monitor CPR quality?
Yes, quantitative waveform capnography allows healthcare personnel to monitor CPR quality
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Why is CPR needed immediately following defibrillation?
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What is done immediately post shocks?
Resume high quality CPR
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How long should compressions be held for rhythm checks?
Just long enough for the AED to analysis the rhythm
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What vasopressor and dose will you give to your patient in VF?
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If IV access is not available what is the next best-preferred route for medication administration?
IO
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At what SBP, would you consider treatment for hypotension?
Less then 90 SBP
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What is the recommended IV fluid bolus and amount to treat hypotension?
1 to 2 liters of normal saline or lactated ringers
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What is the rate for an epi drip?
2 to 10 mcg per minute infusion; titrate to patient response
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What is the second dose of amiodarone in VF?
150 mg
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During a code, are drug administrations and advanced airway a primary importance?
No, they are secondary to high quality CPR
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What is the energy level for biphasic cardioversion of unstable atrial fibrillation?
120 to 200 joules
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Why is the IO route considered over the ETT route for medication administration?
It has a more immediate affect
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Can IO access be established in the elderly?
Yes
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What drugs can be administered via the IO route?
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When would you NOT consider targeted temperature management (TTM) after ROSC?
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If necessary, what drugs can be given via the ETT?
- Narcan
- Versed
- Epinephrine
- Lidocaine
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How would you administer drugs via the ETT route?
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What is the definition for PEA?
Pulseless electrical activity is an organized rhythm without a pulse.
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For PEA, what drug and dose would you give?
Epinephrine and other medications, depending on the cause of the PEA arrest
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What is the maximum total dose of atropine?
1 mcg IV/IO Epinephrine can be given every 3 to 5 minutes x 3; therefore, the maximum amount that can be given is 3 mcg
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What would be two acceptable reasons to stop or withhold CPR?
ROSC or to allow the AED to analyze for a shockable rhythm and to deliver a shock
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After giving a drug, how long do you provide CPR?
2 minutes
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Name the H’s
- Hypovolemia
- Hypoxia
- Hydrogen ion (acidosis)
- Hypo-/hyperkalemia
- Hypothermia
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Name the 5 T’s
- Tension pneumothorax
- Tamponade (cardiac)
- Toxins
- Thrombosis (pulmonary)
- Thrombosis (coronary)
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Would you give NTG to a patient with an inferior wall MI or with right ventricular infarction?
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Symptomatic bradycardia exists when what three criteria are present?
- The heart is slow
- The patient has symptoms
- The symptoms are due to the slow heart rate
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If atropine is ineffective for symptomatic bradycardia, what will you do next?
- Transcutaneous pacing
- Dopamine
- Epinephrine
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What is the KEY critical concept to consider in treating bradycardia?
Is the patient symptomatic
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Is pacing recommended for asystole?
No
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For stable narrow QRS complex tachycardia, how would you treat?
- Adenosine - Initial bolus of 6 mg given rapidly over 1 to 3 seconds followed by NS bolus of 20 mL
- Second dose 12 mg can given in 1 to minutes if needed
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What are the key questions to ask when evaluating a patient with tachycardia?
Is the patient symptomatic, and consider the cause
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For stable regular wide complex tachycardia, how would you treat?
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Why is it important to synchronize cardioversion?
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Why is a CT scan critical to determine treatment for stroke?
To rule out a hemorrhagic stroke
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Why is it best to call EMS versus driving someone to the ER?
Promote early life saving interventions
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How many times will you shock a patient in VF?
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In a suspected stroke patient, fibrinolytic therapy can be started as soon as possible if:
A hemorrhage stroke has been ruled out
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What is the goal time for ED door-to-balloon inflation PCI for a STEMI patient?
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